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Young body-builders beware: Supplements can be dangerous

Teen athletes who turn to pills and powders for a performance boost could face unexpected health risks

Published: October 2013

With all the news about professional athletes being punished for their use of performance-enhancing drugs and banned supplements, you might think teens today would stick to a traditional–and natural–plan for athletic improvement. But not so.

Many more teens than previously thought are turning to sports-related supplements, according to a study of nearly 3,000 adolescents in the December 2012 issue of Pediatrics. One out of four boys regularly used a protein supplement or other muscle-enhancing substance, and almost half at tried them at least once. Nearly six percent crossed the line of the law and took anabolic steroids, which further highlights just how carefree teens can become in their quests for “success.” Such steroids can cause heart issues, psychiatric disorders, impotence, and infertility, among other serious adverse effects.

And it’s not just high school jocks, says the study's author Marla Eisenberg, Sc.D., M.P.H., an associate professor of pediatrics at the University of Minnesota. “While most of the muscle-enhancing behaviors we studied were more common among young people involved in organized sports, a substantial number of kids not on sports teams also reported these behaviors,” she said. Surveys of athletes suggest that up to half of high school senior boys take the muscle-building supplement creatine, and its use has been reported in young athletes still in the sixth grade.

One explanation: Kids see professional athletes, such as the major league pitcher Clayton Kershaw and the Olympic marathoner Ryan Hall, endorsing protein supplements in ads. And they also see the success these athletes have achieved. “When it becomes clear to kids that professional athletes are using supplements and it’s good for their careers, then the assumption is, ‘If I can take something that’s safe and sold over-the-counter then I can do the same without harming myself,’ ” said Pieter Cohen, M.D., an internist at the Cambridge Health Alliance and an assistant professor of medicine at Harvard Medical School.

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Blame the system, not the kids

Tainted dietary supplements have accounted for slightly more than half of all drug-related recalls since 2004. In each case, the supplement contained pharmaceutical ingredients (such as steroids) that could have caused “serious adverse health consequences or death,” according to research published by JAMA Internal Medicine on April 15, 2013. Most of the products recalled were bodybuilding, weight loss, or sexual enhancement products.

“Many of these substances are essentially hormones, so the side effects are related to changes in secondary sex characteristics—facial hair growth in women, breast development in men,” Eisenberg said. “This could have lasting effects for young people going through puberty.”

What’s more, supplement manufacturers can make claims without solid scientific evidence behind them. In fact, the evidence of effectiveness for most supplements is nonexistent.

“A major flaw in the law is that manufacturers don’t need to provide a shred of data showing that these supplements do what they say they will,” Cohen said. In addition, a product might be labeled as “all natural,” but that doesn’t mean it’s safe (venomous snakes are natural, too) or, for that matter, made from a natural source. “Many of them haven’t seen the light of day,” he said. “They’re made in factories.” Remember: supplement products don’t have to undergo safety testing by the government before reaching store shelves.

In a survey of 1,022 U.S. adults conducted in May by the Consumer Reports National Research Center, 47 percent thought that the government must review the products before they go on the market. And 55 percent of respondents thought that the government required companies to include warnings about the potential dangers and side effects of supplements. Wrong on both accounts.

What you can do

Consumers Union, the policy and action arm of Consumer Reports, urges parents to contact their lawmakers at senate.gov and house.gov and urge them to pass a new bill in congress, called the Dietary Supplement Labeling Act. Sponsored by Sen. Dick Durbin, D-Ill., and Sen. Richard Blumenthal, D-Conn., the bill would demand more information on labels and require manufacturers to register products and ingredients with the FDA. The bill would help ensure that supplement makers put safer products on shelves, especially since the legislation also forces manufacturers to provide evidence for any cited claims.

What kids might be taking

Here’s the inside scoop on some ingredients found in sports-related supplements.

Caffeine

What is it? A chemical that can stimulate the central nervous system, possibly increasing your alertness and energy levels. It’s found in energy drinks such as 5-Hour Energy, Amp, and FRS Healthy Energy. Read our special report, "The Buzz On Energy Drinks."

What you need to know

Caffeine is a restricted substance by the National Collegiate Athletic Association, which tests its athletes for excessive intake.

Incident reports filed with the FDA have linked the energy drink Monster with five deaths in recent years. Other research suggests that more than 13,000 people a year visit U.S. emergency rooms because of symptoms associated with energy drinks.

Caffeine levels in energy drinks can range from 6 milligrams to 242 milligrams per serving, according to our Ratings of the drinks. But according to a study published this year in the journal Primary Care: Clinics in Office Practice, the most often used dose for performance enhancement is 420mg (for a 150-pound athlete). By comparison, an 8-ounce cup of coffee has about 100 milligrams; a 16-ounce Starbucks Grande, 330 milligrams. Yet there is no clear dose-response relationship at that amount and likely a plateau effect at 200mg.

Safe limits of caffeine consumption are still being studied, but data suggest that most healthy adults can safely consume up to 400 milligrams per day.

Watch our video on caffeine, below.

Creatine monohydrate

What is it? A nonessential dietary element found in meat and fish (particularly herring, salmon, and tuna). Creatine can boost muscle mass and improve performance in weight lifting and other similar kinds of high-intensity exercise. It can also increase strength gains and aid in muscle recovery. Brands include GNC Pro Performance Creatine Monohydrate and NOW Sports Creatine Monohydrate Powder.

What you need to know:

The ingredient hasn’t been proven safe or effective in children or adolescents. Due to the unknown risks, the American Academy of Orthopaedic Surgeons advises that children and adolescents shouldn’t take creatine supplements.

Long-term studies in all age groups are needed, although creatine is probably safe when used by adults in reasonable amounts.

Adults should consume no more than 5 grams per day of supplemental creatine, according to a risk assessment published in 2006 in the journal Regulatory Toxicology and Pharmacology. Higher amounts have been linked to kidney damage, although the evidence isn’t conclusive.

Not everybody responds to the ingredient in the same way. People who have naturally higher stores of creatine in their muscles tend to not get an effect from supplementation.

Photo:
CreaFuse

DMAA

What is it?

While it has been marketed as a natural stimulant, it’s actually a pharmaceutical amphetamine derivative (called 1,3-dimethylamylamine) that was introduced in 1948 by Eli Lilly & Co and subsequently withdrawn by the 1970s. But it has been used in about 200 supplements since then, such as OxyElite Pro and Jack3d—problematic versions of both have been removed from the market.

What you need to know

The Food and Drug Administration considers DMAA an illegal supplement ingredient. In April, the FDA said that it was “using all available tools at its disposal to ensure that dietary supplements containing DMAA are no longer distributed and available for sale to consumers in the marketplace.” But products have lingered on store shelves.

It has been linked to multiple serious adverse events, including panic attacks, seizures, arrhythmias, and death.